Juvenile Diffuse Laryngeal papillomatosis: case report

Introduction. Juvenile laryngeal papillomatosis is a rare benign neoplasm of the larynx in children; incidence is estimated about 4.3/100.000 children and extralaryngeal spread to the lower airway is relatively uncommon. Although it has a clear viral origin factors that characterize the onset and progress are still uncertain. Materials and methods. We report a 7 year old boy with chronic dysphonia, dyspnoea, haemoptysis and anemia who was admitted in our Clinic. The patient was submitted to left cord vocal biopsy for hoarseness. At 2 years it was diagnosed squamous papilloma and it was managed with microdebrider in another country . A laryngo-tracheo-bronchoscopy was performed with biopsies for viral identification and histology, treatment with laser CO2, tracheotomy for diffuse papillomatosis and intralaryngeal antiviral injection. The papillomatosis was extended in glottic and subglottic. Histological report is laryngeal papillomatosis due to HPV types 11. Identification of HPV genotypes was based on PCR. Results. He had 3 procedures of laser CO2 and the mean time between two consecutive surgeries was 20 days. A third laryngoscopy, after 5 week, found no lesion, no scar formation, no bleeding. The patient was discharged after 3 mounth. Conclusion. The natural history of laryngeal papillomatosis is highly variable and unpredictable. The disease may undergo spontaneous remission, persist in a stable state requiring only periodic surgical treatment, or may be aggressive, requiring surgical treatment every few days to weeks and consideration of adjuvant medical therapy.